Care Home: Woodview House Nursing Home

What the care home does well The registered manager and staff provided specialist care and support for people who have advanced dementia and sometimes have challenging needs. All previous good practice recommendations had been put in place. There were comprehensive assessments of each person`s needs prior to admission. Information was used to develop person centred care plans, which provided staff with guidance to meet each person`s needs.Visitors to the home told us that they were always made welcome. The organisation`s policies demonstrated a positive attitude to complaints and the protection of vulnerable people. The home was clean, free from any offensive odour, appropriately decorated and well maintained with good quality furnishings and furniture. Five new nursing profile beds had recently been provided so that physically frail people could be nursed with more comfort. There was an appropriate skill mix of staff and an excellent Registered Manager. There was a strong commitment to staff training and development, which benefits people using the service. Recruitment and selection procedures are robust and safeguard the people living at the home. Health and safety was proactively managed, with records of fire drills and an accident analysis and evaluation to minimise risks. What the care home could do better: A number of good practice recommendations were suggested to be implemented to further improve the excellent standards of care provided, these included: Minor improvements should be made to the medication system, so that each person`s optimum health is maximised. Monthly evaluations of care plans should include a summary of the person`s progress or deterioration to be a useful record. The pressure settings on pressure relieving mattresses should be recorded in care plans and diligently monitored so that they are effective and comfortable for people needing to use them. Records of pressure ulcer care should be expanded to show how often the wound should be reviewed and what dressings should be used. Specialist diabetic training should be accessed to improve nurses and carers` knowledge and skills to enhance the very good care already provided. Random inspection report Care homes for older people Name: Address: Woodview House Nursing Home Hagley Road Hayley Green Halesowen West Midlands B63 1EN three star excellent service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jean Edwards Date: 1 2 0 4 2 0 1 0 Information about the care home Name of care home: Address: Woodview House Nursing Home Hagley Road Hayley Green Halesowen West Midlands B63 1EN 01215856440 01215850778 admin@hamptongrange.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) John Griffin Type of registration: Number of places registered: Conditions of registration: Category(ies) : Shaw healthcare (Homes) Ltd care home 24 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 24 24 Age: Dementia (DE) age 50 and above. Mental disorder, excluding learning disability or dementia (MD) age 50 and above. The maximum number of service users who can be accommodated is: 24 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 24, Mental disorder, excluding learning disability or dementia (MD) 24 Date of last inspection Care Homes for Older People Page 2 of 11 Brief description of the care home Woodview House is a 24-bedded home accommodating older people with Dementia/Mental Health disorder. The home is built on one level, and offers pleasant gardens to the rear. It is situated off the main Hagley Road within a small housing estate, ample car parking spaces are available. All of the rooms are single occupancy (none are en-suite) and offer comfortable and pleasant accommodation. Woodview House has a large lounge and dining room with smaller quiet lounges, conservatory, activities room and an activities kitchen. The home provides regular therapeutic and recreational activities. Visitors are welcome at any reasonable time. Fees are covered by block contract with the Primary Care Trust for continuing care. Care Homes for Older People Page 3 of 11 What we found: We, the Care quality Commission (CQC) undertook this random inspection visit to monitor standards of care at the home, which was rated as excellent at the last key inspection on 16 April 2007. This random inspection was unannounced, which meant the home was not given notice of our visit. We spent part of a day at the home and looked at the medication systems, care records, staffing and recruitment, and management systems. We looked at how peoples healthcare needs were being managed. We also looked at how people were supported and given assistance to promote their health and well being. We briefly looked around the premises, including communal areas and a sample of bedrooms. We spoke to people who were able, and to staff and visitors. We observed interactions with people without verbal communication. We looked at a sample of the medication held at the home. We noted that staff were knowledgeable about medication. There were areas of good practice with medication well organised and we saw that medicines were administered to people in a timely manner, with appropriate records. There were photographs with the MAR (Medication Administration Records) charts, which minimises any risk of medication being given to the wrong person. We noted that handwritten entries on MAR charts had been signed and witnessed by two trained staff, which demonstrated good practice and reduced the risk of errors. There were a small number of areas, which needed to be improved. We noted that staff were not recording carried forward balances of pain relieving medication stocks on the MAR charts, which meant that the accurate auditing of medication dispensed in original containers could not be easily carried out. We saw that two people had been prescribed antibiotics but the codes on MAR charts showed that they had not received the amount of doses prescribed each day. The codes entered indicated that they were asleep at the administration times, especially in the late evening. We recommended that discussions should take place with the doctor and administration times should be adjusted so that the correct numbers of prescribed doses are administered. This will ensure the efficacy of the medication. The registered manager acknowledged that there were no short term care plans in place for the people requiring this medication. He gave us assurances that good practice recommendations would be put in place. We noted that a Deprivation of Liberty safeguarding assessment was in place for a person refusing their medication. This meant that medication to maintain their health could be given covertly that is disguised in food. The service demonstrated excellent practice, with appropriate protocols, the involvement of relevant professionals and an independent advocate. This process protected the person from risks of harm. We looked at the storage and administration of controlled drugs, which was satisfactory, with all records and balances of medication accurate. This meant that people requiring these medicines were receiving them as prescribed by their doctor. We looked at the care records for three people. The registered manager explained that the home had been trialling different care planning formats to make care plans more Care Homes for Older People Page 4 of 11 person centred and easier to read essential information. We saw that care plans reflected the assessed needs, they were up to date and provided essential information to ensure each persons needs were understood and met. Care plans had monthly evaluations and daily records were maintained by each shift. The records were well organised to good standards. Further improvements should include care planning evaluations, which could be made more meaningful with a summary of specific number of incidents, or events that have occurred each month. We saw that people had good access to health care professionals such as GPs, dentist, ophthalmic and chiropody services. We noted that the home provided appropriate care for people vulnerable to pressure ulcers and diabetes. We noted that a person with unstable diabetes had fluctuating weight and recommended that advice should be sought from the specialist diabetic team and community dietician. However the registered manager told us that diabetes was managed by the GP who was not concerned about the persons weight fluctuations. We spoke to staff about the management of unstable diabetes and they demonstrated generally good awareness. The registered manager told us the staff had not received specialist diabetic training and acknowledged that additional training would be beneficial to enhance skills and knowledge, improving the care for people with diabetes. We saw that appropriate care was being provided for someone who had a pressure ulcer. However the audit trail of dressing regimes could be improved with more detailed wound care charts. We saw that equipment, such as adjustable nursing profile beds and pressure reliving mattresses were provided as needed. We recommended that the pressure setting for the mattresses should be recorded and monitored to be comfortable and effective for each person. We saw that people looked well presented and were dressed appropriately according to their preference. There was very good interaction between staff and the people living at the home, with conversation at a level and pace appropriate for each person. We spoke with relatives who told us they felt the home deserved its excellent status and commented, the home does everything well, staff are caring, X seems contented, this is her home, carers are her family, she smiles and recognises the carers. When she is poorly they are quick to get the doctor and keep us informed. She looks well cared for, kept clean and tidy with changes of clothes if there are food spills. Staff are aware of her likes for example likes to watch TV, chocolate cake and loves music, particularly the entertainer who comes to the home and uses musical instruments. We looked at the homes systems to deal with complaints. We saw that there was a compliments, complaints and suggestions procedure displayed in the home and available in the Service User Guide. The registered manager told us that there had been no complaints or safeguarding referrals in the past 12 months. We spoke to relatives, who told us they had no complaints but could tell the staff or manager if they wanted to raise any concerns. There were corporate policies and procedures to inform staff about abuse and responsibilities for reporting suspicions or incidents. We were told that there was a programme of safeguarding training provided by the organisation. This was confirmed by staff. We discussed the freely available safeguarding training provided by Dudley Directorate of Adult, Community and Housing Services (DACHS), which is the lead agency Care Homes for Older People Page 5 of 11 and ensures staff are familiar with the Safeguard and Protect multi-agency procedure. We recommended that an up to date version of Safeguard and Protect should be obtained. We looked briefly around the premises and noted maintenance was being carried out to acceptable standards. There were improvements such as the recent purchase of five nursing profile beds, providing comfort for people as they became more physically frail. We saw that there were 22 people accommodated at the home, on three units, with a range of diverse needs. We looked at copies of staff rotas and discussed the staffing levels with the registered manager in relation to occupancy and dependency levels. He was able to give us detailed information about the people accommodated, to identify what were their diagnosed conditions were and the numbers of nurses and carers to meet their needs. We looked at a sample of two personnel files of staff recently employed. The files were well organised with a recruitment checklist. The recruitment process was robust and provided safeguards for people living at the home. The Registered Manager, John Griffin, a well qualified and experienced registered nurse and manager, had worked at the home since 1997. He was continuing his own professional development with a management programme provided by the organisation. There were quality assurance checks and rigorous audits, with remedial actions for improvements. Examples were the management and administration of medication, the standards of the premises and the rigorous recruitment to safeguard people at the home. There were Regulation 26 visits and reports from the Area Manager; and we were told he frequently visited the home. The Area Manager provided regular formal supervision as support for Registered Manager in addition to ad hoc supervision and advice when needed. There was delegated supervision system and the registered manager has devised a calendar system to ensure that each person was easily six supervisions each year. The fire safety records appeared satisfactory and we noted that there were regular fire drills. There were incidents and accident records with accident analysis and evaluation, which was good practice to identify trends and identify risks, which nurses used to revise and update individual risk assessments to control or minimise hazards. What the care home does well: The registered manager and staff provided specialist care and support for people who have advanced dementia and sometimes have challenging needs. All previous good practice recommendations had been put in place. There were comprehensive assessments of each persons needs prior to admission. Information was used to develop person centred care plans, which provided staff with guidance to meet each persons needs. Care Homes for Older People Page 6 of 11 Visitors to the home told us that they were always made welcome. The organisations policies demonstrated a positive attitude to complaints and the protection of vulnerable people. The home was clean, free from any offensive odour, appropriately decorated and well maintained with good quality furnishings and furniture. Five new nursing profile beds had recently been provided so that physically frail people could be nursed with more comfort. There was an appropriate skill mix of staff and an excellent Registered Manager. There was a strong commitment to staff training and development, which benefits people using the service. Recruitment and selection procedures are robust and safeguard the people living at the home. Health and safety was proactively managed, with records of fire drills and an accident analysis and evaluation to minimise risks. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Care planning evaluations should be made more meaningful, for example, recording the specific number of incidents, or events, and actions which have occurred during the evaluation period. Specialist diabetic training should be provided for all staff to enhance their knowledge, skills and practice. There should be comprehensive wound care records, showing location, size, grade, dressing regime, frequency, monitoring. Short term care plans should be used to provide guidance to meet additional needs for time limited conditions such as infections. The timing of administration of medication, such as antibiotics should be monitored and adjusted where necessary, in consultation with a doctor, to ensure that the person receives a full amount of doses of medication as prescribed. Carried forward balances of medication such as pain relief should be recorded on the MAR charts. Page 9 of 11 2 3 7 7 4 7 5 9 6 9 Care Homes for Older People Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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